<extend name="./Tm/Dt/User_common.html" />

<block name="main">
	<div class="right_main">
		<div class="panel panel-default">
		  	<div class="panel-heading">
		  		<i class="inde_icon icon_jjmx"></i>我要留言</span>
		  	</div>
	  		<div class="panel-body">
				<div class="pad-20"></div>
				<div class="pad-20 pp">
					<form class="form-horizontal" action="/user/ly_form" method="post">
						<div class="form-group">
							<label for="inputEmail3" class="col-sm-2 control-label">标题<span>*</span></label>
							<div class="col-sm-3">
								<input type="text" class="form-control" id="inputEmail3" name="title">
							</div>
						</div>
						<div class="form-group">
							<label for="inputPassword3" class="col-sm-2 control-label">联系方式<span>*</span></label>
							<div class="col-sm-3">
								<input type="text" class="form-control" id="inputPassword3" name="phone">
							</div>
						</div>
						<div class="form-group">
							<label for="inputPassword3" class="col-sm-2 control-label">收信人类型<span>*</span></label>
							<div class="col-sm-3">
								<input type="text" class="form-control" id="inputPassword3" name="sjr">
							</div>
						</div>
						<div class="form-group">
							<label for="inputPassword3" class="col-sm-2 control-label">内容<span>*</span></label>
							<div class="col-sm-3">
								<textarea style="width: 100%;height: 100px;" name="content"></textarea>
							</div>
						</div>
						<div class="form-group">
							<div class="col-sm-offset-2 col-sm-10">
								<button type="submit" class="btn btn-default">提交</button>
							</div>
						</div>
					</form>
				</div>
			</div>
		</div>
	</div>
</block>